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NPI Code Detail

MEDICARE: SHERRI P LUCKE LMP

MEDICARE:   SHERRI P LUCKE  LMP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225700000XMassage TherapistMA00018902WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
18930866OTHERWACRIME VICTIMS
28166LUOTHERWAREGENCE BLUE SHIELD
3183083OTHERWADEPT OF LABOR & INDUSTRY

General Provider Information

NPI Number : 1780760462
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHERRI P LUCKE LMP
Provider Business Mailing Address
First Line : 790 REMINGTON BLVD
Second Line :
City : BOLINGBROOK
State : IL
Zip : 60440-4909
Country : US
Telephone Number : 630-296-2223
Fax Number :
Provider Business Practice Location Address
First Line : 201 160TH ST S
Second Line : STE 301
City : SPANAWAY
State : WA
Zip : 98387-8508
Country : US
Telephone Number : 253-531-4100
Fax Number : 253-531-3795
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/27/2006
Last Update Date : 11/23/2015

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Directions to “ SHERRI P LUCKE LMP” Practice Location

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